Patient Satisfaction Survey

In-Office Endoscopy

Would you please take time to fill out this survey, so that we may better serve our patients? After you answer the following questions, click on the "Submit" button below to email your responses to us. If you prefer, you can open and print this form as an Adobe Acrobat (.pdf) file.

Your name (optional):

The amount of time it took for the initial process of signing in and filling out paperwork.

The kindness shown by the patient care staff.

The explanation of the Prep and procedure instructions.

The staff's respect for patient's privacy.

The staff informing the patient of any delays in care and/or treatment.

The amount of time waiting at the facility.

The cleanliness of the facility.

Discharge instructions explained clearly.

Overall experience.

Any suggestions for improvement:

Is there a specific employee whom you would like to see congratulated or thanked for the care he/she provided during your visit at this office?

Based on your experience at this office, would you recommend a family member or friend?